India has an ambitious goal: to eradicate malaria by 2030.
But first it must eradicate low-quality antimalarials. These substandard and counterfeit medicines create antimalarial resistance, increasing case numbers and causing more illness and death.
Malaria killed 627,000 people globally in 2020, according to the World Health Organization (WHO). India’s ‘malaria map’ has contracted in recent years as some high-transmission areas have become low-transmission areas, but the country still bears the brunt of Southeast Asia’s malaria burden, with 82.5 percent of the region’s 5 million annual cases. Malarial parasites are developing resistance to the antimalarial agent artemisinin and mosquitoes (which carry the parasites) are developing resistance to insecticides, creating challenges for malaria control and elimination. There is no global system for collecting essential data, such as region- specific information on the clinical and parasitic response to particular antimalarials, and the migration and transmission rate of malarial parasites, which makes it difficult to identify hot spots and eradicate low-quality antimalarials. When 119 random samples of chloroquine-based antimalarials from pharmacies in the Indian cities of Delhi and Chennai were screened, 7 per cent were found to be substandard. In India, regulatory issues such as inadequate testing facilities and lack of uniform enforcement contribute to the problem of substandard medicines.
